My Journey from Fatman to 140.6 Triathlete

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The Diagnosis

The first thing I did was ask for referrals. I asked my run coach and my doctor for the top docs in Chicago who are not “knife crazy”. At this point I was terrified about the idea of surgery and in denial actually that i would need it. I have been down this path before with my running. Ankles, backs, etc. and have always managed to use conservative treatment (PT, muscle work, etc) to counteract the aging body.

Amazingly between the 2 lists, there were 2 names in common! And both were in network for my insurance, which is even more amazing!

I asked my run coach for a preference and started there, booked an appointment with Dr Patrick Birmingham. Took a few weeks to get in.

Immediately he did an x-ray and an extensive history. I knew he worked with athletes, but I always worry that they see this fat guy and just tell me to “rest it” (I know I am not that fat, but I don’t “look” like a typical endurance athlete). He read the history the nurse took, he understood it, and he didn’t ask me anything redundant nor did he just say “well, I guess your running days are over” – nope. His focus was figuring it out to get me back to being as active as I could be. Immediately, I liked him 😉

The little angle markers he used were to show me that there is an “over hang” of bone in the socket and the head of the femur is slightly flattened. Both mean likely Femoroacetabular Impingement (FAI). The socket side growth is called a “PINCER” and the ball side growth “CAM” and it was possible I had both. More testing needed to be sure. However, this condition is not uncommon. It is not “caused” by exercise but symptoms are likely to come earlier to those who are active. But regardless, eventually it would happen. By itself this is no cause for alarm, but where the bones touch is the Labrum and that could get torn by the repetitive hits.

Next step was an MRI to rule out “the real bad stuff” like stress fracture, tumors, etc.

More waiting. Insurance took 2 weeks to approve it, then book it, then get it, then get the reading and followup. Another month gone by. Still trying to run and not getting anywhere at all. A year ago I was doing a marathon, now I cannot push out a 24min run/walk with only 30second run intervals.

Daily function was impacted. I was uncomfortable, a lot, and I randomly would exhibit symptoms in daily life and be unable to walk. This was not fun.

Went back for followup – MRI’s are hard to show you guys anything, so no pictures. Basically they didn’t find anything crazy bad and we didn’t know from the Xray. Labrum tear was seen, not by the radiologist but but Dr B.

FUN TIP: I since learned that unless they do an MRI with contrast, the radiologists in the midwest do not even look for tears. They are harder to see, but the contrast doesn’t add much to the accuracy. There are other forms – MRI with contrast and another where they inject contrast into the hip, but Dr B felt that it really didn’t give us much more information than a normal MRI because even a tear could be without symptoms. A clearer picture doesn’t tell us anything “more”.

That’s the good news, the bad news is it not conclusive. What else could cause my problems?

Back. Especially since I have some arthritis in L3-5 and some other stuff in L1-2. From years of being super fat, sitting all day for work, and some genetics it has taken it’s toll.

Muscles. It is entirely possible there is a muscle imbalance going on making the hip not work right. This is tougher because it could be some muscle not firing right or at all and others compensating – which usually is only short term before they give out because they were not designed to do that work.

Next step? Inject the hip with lidocaine then try to reproduce the pain (or in my case, non-function). We expected this was possible and I was anxious to get this show on the road, so we did it right then and there.

so they take this super long needle and go in through the outside of your hip into the joint. In my case the initial push in didn’t hurt much – just a pinch – but they go through the meat of the muscle and the muscle decided this was NOT OK and cramped real bad. They held me down and told me to not move (hah!) and then gave a good hard shove to get it through the muscle body and into the joint. Then about 5 seconds of injection time before they pulled out. Although not comfortable, it wasn’t horrible.

They had me move around and walk and then told me to go run. After talking to my coach she said I could try to run up to 52 minutes (32 had been my max in months) so I went to a nearby park and did just that. At 14min I felt a tiny pinge of tightness and my heart sank. If this didn’t work, then it was muscle/back and I was going to be in for a long and expensive and possibly not covered by insurance journey. I was really starting to get bummed out but by minute 15 – it was gone. I ran all 52 minutes pain and tightness free. Then to REALLY prove it I walked up and down this big sled hill 7x for about 35minutes. That was similar to what I was doing at scout camp.

I stopped around 90 minutes and walked back to the car. No tightness. No pain. Just tired muscles. Bittersweet because….

CRAP. This means surgery.

Because I was in denial and still trying to avoid it, I went back 2 days later and tried to repeat the same protocol, same course, everything. I made it 14 minutes.